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Laura Bragonzoni,1 Giuseppe Barone,1 Francesco Benvenuti,1 Claudio Ripamonti,2 Lucia Lisi,2 Maria Grazia Benedetti,3 Sofia Marini,1 Laura Dallolio,4 Pasqualino Maietta Latessa,1 Raffaele Zinno,1 Giuseppe Audino,1 Wolfgang Kemmler,5 Erika Pinelli1 1Department for Life Quality Studies, Campus of Rimini, University of Bologna, Bologna, Rimini, Italy; 2Center for Osteoporosis and Bone Metabolic Disease, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy; 3Physical Medicine and Rehabilitation Unit, IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy; 4Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy; 5Institute of Medical Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, GermanyCorrespondence: Giuseppe Barone, Department for Life Quality Studies, Campus of Rimini, University of Bologna, Via di Barbiano, 1/10, Bologna, Rimini, 40136, Italy, Tel +39 051 636 6507, Email giuseppe.barone8@unibo.itPurpose: We compared two different strategies providing professional coaching to administer an exercise program for women with postmenopausal osteoporosis (POP): individual training (IT) at home with trainer’s supervision provided by telephone contacts at regular time-intervals or group training (GT) with trainer’s live supervision. Our working hypothesis was that IT is a valid alternative to GT when GT is not feasible.Patients and Methods: This was a single-blind, randomized study. We recruited 52 women with POP, without significant comorbidity, and no participation in any structured exercise program within the previous 6 months. They were assigned randomly to IT or GT groups (n = 26 each). Distribution of age (IT: 68± 4, GT: 67± 8 years) and body mass index (IT: 23.0± 2.5, GT: 21.4± 5.1) was similar between groups. Each group performed the exercise program in two 1-hour sessions per week for 18 months. Primary outcome measure was Health-Related Quality of Life (HRQoL), as measured by the Short Osteoporosis Quality of Life Questionnaire. Secondary outcome measures focused on domains acknowledged to influence HRQoL (disability, fear of falling, weekly physical activity, physical function) or the effectiveness of the exercise program (retention, adherence, and safety). Significance level was set at p < 0.05.Results: No significant differences were observed between IT and GT groups for any domain. Retention, adherence, and safety were also similar. HRQoL, disability and fear of falling did not change between baseline and follow-up for either group. However, for both groups, physical function (knee flexion, shoulder mobility) and functional capacity (6-minute walking test) improved. Weekly physical activity levels increased from moderate range at baseline to intense at final assessment for both groups.Conclusion: IT and GT supervised exercise programs for women with POP provide similar effectiveness, participation and safety. Hence, both modalities should be considered for future translation in clinical practice of exercise recommendations for POP.Keywords: coaching, encouragement, exercise, physical activity, postmenopausal osteoporosis, quality of life

Michael Hettchen,1 Simon von Stengel,1 Matthias Kohl,2 Marie H Murphy,3 Mahdieh Shojaa,1 Mansour Ghasemikaram,1 Laura Bragonzoni,4 Francesco Benvenuti,4 Claudio Ripamonti,5 Maria Grazia Benedetti,6 Mikko Julin,7 Tapani Risto,7 Wolfgang Kemmler1 1Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany; 2Department of Medical and Life Sciences, University of Furtwangen, Schwenningen, Germany; 3Doctoral College, Ulster University, Newtownabbey, Antrim, Northern Ireland, UK; 4University of Bologna, Campus Rimini, Rimini, Italy; 5Center for Osteoporosis and Bone Metabolic Disease, Rizzoli Orthopaedic Institute, Bologna, Italy; 6Physical Medicine and Rehabilitation Unit, IRCCS - Rizzoli Orthopaedic Institute, Bologna, Italy; 7Laurea University of Applied Sciences, Espoo, FinlandCorrespondence: Michael HettchenInstitute of Medical Physics, Friedrich-Alexander-University Erlangen-Nürnberg, Henkestrasse 91, Erlangen 91052, GermanyTel +49 9131-8525883Fax +49 9131-8522824Email michael.hettchen@imp.uni-erlangen.deAbstract: The menopausal transition is a critical period in women’s lives. Exercise might be the most promising non-pharmaceutic intervention to address the large variety of risk factors related to the pronounced estradiol decline during peri- and early-postmenopause. The aim of this study was to determine the effect of an 18-month multipurpose exercise program on risk factors and symptoms related to the menopausal transition. Fifty-four women 1– 5 years postmenopause with osteopenia or osteoporosis were randomly assigned 1) to a high impact weight-bearing/high-intensity/velocity resistance training group (EG: n=27) exercising three times a week or 2) to an attendance control group (CG: n=27) that performed low-intensity exercise once a week. Both groups were supplemented with cholecalciferol and calcium. The primary study endpoint was bone mineral density (BMD) at lumbar spine (LS) and total hip, secondary outcomes were lean body mass (LBM), total and abdominal body percentage, metabolic syndrome Z-Score (MetS-Z), menopausal symptoms and muscle strength and power. Due to COVID-19, the study was stopped after 13 months. We observed significant effects for BMD-LS (EG: 0.002± .018 versus CG: − .009± 0.018 mg/cm2, p=0.027) but not for BMD total hip (EG: − 0.01± .016 versus CG: − .009± 0.020 mg/cm2, p=0.129). LBM improved significantly in the EG and decreased in the CG (0.39± 1.08 vs − 0.37± 1.34 kg, p=0.026). Total and abdominal body fat improved significantly in the EG and was maintained in the CG (− 1.44± 1.49 vs − 0.02± 1.55 kg, p=0.002 and -1.50± 2.33 vs 0.08± 2.07 kg, p=0.011). Significant effects in favor of the EG were also determined for menopausal symptoms (p=0.029), hip/leg extension strength (p< 0.001) and power (p< 0.001). However, changes of the MetS-Z did not differ significantly (p=0.149) between EG and CG. In summary, with minor exceptions, we demonstrated the effectiveness of a multipurpose exercise protocol dedicated to early-postmenopausal women on various risk factors and complaints related to the menopausal transition.Keywords: multipurpose exercise, bone mineral density, early postmenopause

Purpose: The menopausal transition is a critical period in womens lives. The central aim of the present study was to evaluate the effect of a multimodal exercise protocol on the cardiometabolic risk factor potentially related to menopausal transition in early postmenopausal women. Methods: Fifty-four (54) early-postmenopausal women (54.01.8 years) were randomly assigned to two groups: (1) exercise group (EG: n=27) which conducted a high intensity aerobic and resistance training three times/week and (2) active control group (CG: n=27) exercising once a week with low exercise intensity. Besides bone density, the main variable of this project, the outcome variable in this thesis was also cardiometabolic risk, as summarized by the Metabolic Syndrome (MetS) Z-Score. We applied Intention-to-Treat (ITT) and Per Protocol Analyses (PPA) with multiple imputation and used standardized mean differences to illustrate the effects.Results: After 16 weeks of exercise two participants (EG: n=1; CG: n=1) were lost to follow-up. Effects for the MetS Z-Score were moderate (EG: -0.361.36 vs. CG: 0.512.28; SMD: 0.47, 95% CI: -0.08 to 1.03), albeit borderline non-significant (ITT: p=.089; PPA: p=.060). Conclusion: The present multimodal exercise protocol just failed to affect the MetS Z-Score and its underlying cardiometabolic risk factors. Whether this result can be generalized to the entire cohort of early-postmenopausal women or whether it has to be attributed to the only moderately high exercise intensity during the early weeks of the intervention along with a relatively short intervention period remains to be evaluated.Key Words: Metabolic Syndrome, MetS Z-Score, Menopausal Transition

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